Healthcare Provider Details

I. General information

NPI: 1164827887
Provider Name (Legal Business Name): ROY J. CAPUTO, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S HARBOR BLVD STE A
LA HABRA CA
90631-7577
US

IV. Provider business mailing address

PO BOX 1310
TUSTIN CA
92781-1310
US

V. Phone/Fax

Practice location:
  • Phone: 714-879-3400
  • Fax: 714-441-1998
Mailing address:
  • Phone: 714-403-2483
  • Fax: 951-260-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG57575
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberG57575
License Number StateCA

VIII. Authorized Official

Name: DR. ROY J CAPUTO
Title or Position: OWNER
Credential: M.D.
Phone: 714-403-2483